Cost Is One Snag of Voluntary Reporting Program


In response to why the 9% benchmark was used, Dr. Haywood commented that “there is a lot of debate currently about what is good control, so there has not been any consensus yet. So what we did was say, 'We'll look at poor control as a starting place, and to the extent that we can build toward what is a final determination toward good control, we'll revisit that particular method.'”

Dr. Hamilton disagreed, noting that physicians have held several consensus conferences and put out publications reinforcing that good control is somewhere around 7%–7.5%. “If you really want to measure quality, you need to measure quality,” he said.

Council member Dr. Anthony Senagore, a Cleveland surgeon, said CMS is taking the wrong approach entirely. “Rather than micromanage care, why not go for the 40,000-foot view?” he said. For example, “What is Dr. Hamilton's amputation rate? His patients' renal failure rate? If his amputation rate is zero, who cares what his patients' hemoglobin A1c is—he's a superior provider.”

Dr. Haywood responded that many people disagree on whether it's better to measure process or outcomes. “We don't think it's one way or the other. At the end of the day, we want to get at outcomes, but in the interim, we have process measures that we believe the evidence shows lead to better outcomes.”

The council passed a resolution asking CMS to seek comment from appropriate specialty societies regarding the issues raised by the voluntary reporting program, “and, like the hospital program, pay for data collection.”